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MR Ventriculography for the Study of CSF Flow

Vivek B. Josepha, Lakshminarayan Raghuramb, Ipeson P. Korahb and Ari G. Chackoa

a Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
b Department of Radiodiagnosis, Christian Medical College Hospital, Vellore, India



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  		FIG 1. 65-year old woman with multiple cerebral metastases and hydrocephalus probably secondary to carcinomatous meningitis.

A, Contrast-enhanced CT scan of the brain shows a peripherally enhancing mass (black arrow) in the right frontal region, with surrounding edema. There is dilatation of the lateral and third ventricles that cannot be explained by the location of the mass. Air from the external ventricular drain is noted in the frontal horns (white arrow). Histopathologic examination revealed this tumor to be a metastatic adenocarcinoma.

B, Contrast-enhanced CT scan through the posterior fossa shows another enhancing mass (arrow) in the left cerebellar hemisphere. The recesses of the fourth ventricle are well seen.

C, Contrast-enhanced CT scan shows the dilated upper fourth ventricle with no evidence of basal arachnoiditis.

D, Axial MR ventriculogram shows contrast material in the lateral and third ventricles.

E, Coronal MR ventriculogram shows contrast material in both lateral ventricles, open foramina of Monro, and third ventricle. There is no contrast material in the basal subarachnoid cisterns.

F, Sagittal MR ventriculogram shows contrast material in the lateral, third, and fourth ventricles. Note contrast material exiting the fourth ventricle through the foramen of Magendie into the cisterna magna (arrow).

G, Axial MR ventriculogram shows contrast material in the lower fourth ventricle exiting the foramen of Magendie. Note the absence of contrast material in the right foramen of Luschka.

H, Axial MR ventriculogram shows contrast material in the lower fourth ventricle entering the left foramen of Luschka (white arrow). Note the absence of contrast material in the right foramen of Luschka. The absence of contrast material in the basal subarachnoid spaces and the block in the right foramen of Luschka led us to a diagnosis of basal arachnoiditis due to leptomeningeal seeding in this patient with metastatic adenocarcinoma.



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  		FIG 2. 9-year-old girl with hydrocephalus and hydromyelia.

A and B, Axial contrast-enhanced CT scans of the brain show dilatation of the lateral, third, and fourth ventricles. There is suspicion of a cystic lesion (arrow in B) in the fourth ventricle. MR ventriculography was performed to study the intraventricular CSF flow and to delineate the fourth ventricle.

C, Axial MR ventriculogram after injection of gadodiamide into the right lateral ventricle shows contrast material layered in the dependent portion of the right lateral ventricle (arrow) and no contrast material in the left lateral ventricle.

D, Coronal MR ventriculogram after injection of gadodiamide into the right lateral ventricle shows contrast material limited to the body and temporal horn of the right lateral ventricle (arrow). There is minimal contrast material in the third ventricle, suggesting a partial block in the right foramen of Monro.

E, Sagittal MR ventriculogram after injection of contrast material into the right lateral ventricle shows minimal contrast material entering the third and fourth ventricles. Note the presence of a syringomyelia in the upper cervical cord (arrow).

F, Axial MR ventriculogram through the bodies of the lateral ventricles. Contrast material was injected into the left lateral ventricle 100 minutes after the previous injection into the right lateral ventricle. This image shows a more uniform distribution of the contrast material in the right lateral ventricle, with no evidence of layering.

G, Coronal MR ventriculogram after injection of contrast material into the left lateral ventricle shows good flow of the contrast material through the left foramen of Monro into the third ventricle.

H, Sagittal MR ventriculogram shows flow of contrast material from the third ventricle into the fourth ventricle with no intraventricular lesion. The syrinx in the upper cervical cord (arrow) is again noted.



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  		FIG 3. 6-month-old girl with a Dandy-Walker malformation and aqueductal stenosis.

A, Sagittal MR ventriculogram shows intense contrast in the left lateral and third ventricles. The anterior recesses of the third ventricle (white arrow) and the massa intermedia (black arrow) are clearly visible. There is a thin trickle of contrast material in the cerebral aqueduct, indicating a relative stenosis. The asterisk (*) indicates the posterior fossa cyst.

B, Coronal MR ventriculogram shows intense contrast in the body of the left lateral ventricle, third ventricle, and the left temporal horn. Contrast in the right lateral ventricle is of less intensity (X).

C, Axial MR ventriculogram shows contrast in the third ventricle (arrow) and the left temporal horn (arrowhead). Contrast of less intensity fills the right temporal horn. The posterior fossa cyst (*) has no contrast.

D, Axial MR ventriculogram shows intense contrast in the anteroinferior part of the third ventricle (white arrow) and temporal horn of the left lateral ventricle, and a thin trickle of contrast material in the cerebral aqueduct (black arrow) entering the posterior fossa cyst (*)



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  		FIG 4. 8-year-old boy with a medulloblastoma and hydrocephalus who underwent an emergency third ventriculostomy before excision of the tumor.

A, Nonenhanced axial T1-weighted MR image shows a large hypointense tumor (arrow) in the posterior fossa.

B, Axial MR ventriculogram after third ventriculostomy shows contrast material in the anteroinferior third ventricle (arrow). Note that there is no contrast material in the adjacent suprasellar and sylvian cisterns.

C, Coronal ventriculogram after third ventriculostomy shows contrast material along the external ventricular drain (thin arrow), the frontal horn of the right lateral ventricle (thick arrow), and the third ventricle. Note that no contrast material is seen in the suprasellar cisterns.

D, Axial MR ventriculogram after third ventriculostomy shows contrast material in the right frontal horn (thick arrow) and third ventricle (thin arrow).

E, Sagittal MR ventriculogram after third ventriculostomy shows contrast material in the dependent portion of the lateral ventricle and the third ventricle (thick arrow). There is no contrast material seen in suprasellar cisterns. Note the large hypointense tumor (thin arrow) in the posterior fossa.

F, Postoperative contrast-enhanced CT scan through the posterior fossa shows complete tumor excision.



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  		FIG 5. 49-year-old man with a cystic cervicomedullary schwannoma and hydrocephalus who underwent a third ventriculostomy before excision of the tumor.

A, Axial T1-weighted image through the posterior fossa shows the cystic tumor (arrow) in the left cerebellomedullary angle, compressing the fourth ventricle.

B, Sagittal T1-weighted image shows the cervicomedullary cystic tumor (arrow) with the solid portion inferiorly.

C, Axial MR ventriculogram after third ventriculostomy. The contrast material was injected into the right lateral ventricle. Note contrast material in the right temporal horn, in the suprasellar cisterns (thick arrow), and left sylvian cistern (thin arrow).

D, Axial nonenhanced T1-weighted image for comparison with C.

E, Coronal MR ventriculogram after third ventriculostomy shows contrast material in the bodies of both lateral ventricles. Note contrast material in the left sylvian cistern (arrow).

F, Sagittal MR ventriculogram after third ventriculostomy shows contrast material in the lateral, third, and fourth ventricles. Contrast of lesser intensity is seen in the suprasellar cistern (upper arrow). Note obstruction to the flow of contrast material in the fourth ventricle by the cystic tumor (lower arrow).

G, Sagittal nonenhanced T1-weighted MR image for comparison with F.





Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X